Oral Hypoglycemic Agents Ecab

Even though we have many advances in the development of oral hypoglycemic agents, an ideal drug for treating type 2 diabetes is still a distant reality. Today, physicians can choose from a variety of medications targeting numerous facets of disease, but each drug class poses some limitations. The age-old molecules, such as sulfonylureas and biguanides, are still valued because of their well-studied mode of action, safety, tolerability, and predictable pharmacodynamic effects. This book attempts to describe the historical aspects and advances in the arena of oral hypoglycemic agents, extended- and sustained-release formulations of glipizide and metformin (both of which have great promise in the treatment of type 2 diabetes mellitus) as well as evaluates the role of the group in diabetic foot infections.

Gestational diabetes mellitus (GDM) is classically seen in about 5–8% of the pregnant women. The condition appears to be caused by the same broad spectrum of physiological and genetic peculiarities that characterize diabetes outside of pregnancy. These women with GDM are also otherwise at high risk of having or developing diabetes even when not pregnant. The controversies regarding the diagnosis, management, and prevention of diabetes in pregnancy pose specific problems in clinical practice such as how to clinch the diagnosis, when to introduce therapy, what therapy to introduce, and how to predict the future course of the condition. This book is designed to address such questions with supportive typical clinical scenarios, with which all readers will be able to identify. Thus it provides an excellent opportunity to widen one’s perspective in this area.

Cell health depends on a steady supply of fuel from glucose and free fatty acids. Both these major fuels are regulated by insulin. Cells in the muscle, liver, and fat need insulin to receive glucose, and hence do not become exposed to high blood glucose levels when the blood sugars are high and insulin levels are low. The lack of insulin slows the movement of glucose into these cells, and probably spares them from damage when blood sugars are high. However, other cells such as those in the brain, nervous system, heart, blood vessels and kidneys pick up glucose directly from the blood without using insulin. These cells, except the brain, are more prone to damage from high blood sugars because they become exposed to high internal levels of glucose. This to quite an extent explains why damage tends to occur in specific organs such as in nerve and kidney cells, and in small blood vessels like those in the eyes. This project on the organ damage in diabetes is an attempt to elaborate on the various factors to be considered in managing these patients, the pointers for early diagnosis and prevention of the same.

Critical Issues and Diabetes - ECAB - E-Book

The insulin resistance syndrome can be defined as insulin resistance, compensatory hyperinsulinemia, and their associated co-morbidities. Clinically, the term insulin resistance syndrome describes a constellation of abnormalities such as obesity, hypertension, dyslipidemia, type 2 diabetes/hyperglycemia, and coronary artery disease. Insulin is responsible for glucose uptake into the body cells and tissues. The response of the cells to insulin varies from individual to individual. In some individuals, the tissue response to insulin may be diminished. This means that even with adequate levels of insulin, the glucose uptake into the cells and tissues is not optimal. This results in a compensatory over-secretion of insulin from the pancreas. The persistence of high levels of insulin in the blood or hyperinsulinemia is thought to be responsible for some of the abnormalities associated with this condition. However, the exact causal association of the condition with these disorders and the pathophysiology of their evolution are unclear. The most common underlying mechanism proposed is increased free fatty acids from abdominal fat in individuals with central obesity. This leads to deranged insulin signaling, reduced muscular glucose uptake, increased triglyceride synthesis, and hepatic gluconeogenesis. A genetic basis of the disease as well as several other factors such as tumor necrosis factor-α, adiponectin, leptin, Interleukin-6, and some adipokines have also been implicated. Insulin resistance syndrome is of clinical significance because of its association with potentially debilitating conditions that contribute to long-term morbidity and even mortality of the individual. People with insulin resistance syndrome are at an increased risk of developing type 2 diabetes, hypertension, dyslipidemia, myocardial infarction, polycystic ovarian disease, and fatty liver. In this book, we have tried to collate the experiences of the pioneers of this field on the subject and provide the reader a comprehensive view on the topic along with practical management points, which we are sure will benefit the physicians in their clinical practice. The contributors have focused on the condition as is prevalent in our subcontinent and have tried to give an insight on the issues pertaining to the same with a topical flavor.

Diabetes is a chronic disease that is reaching an epidemic proportion in many parts of the world. Despite the high incidence of diabetes, individuals diagnosed with the disorder are only 50%. The main challenge of medical professionals in diagnosing and treating the diabetic patients is the lack of understanding of the disease, which usually leads to problems with treatment compliance and monitoring. There is strong evidence to show that an effective intensive glycemic control reduces various microvascular and neuropathic complications of diabetes mellitus. The Diabetes Control and Complications Trial (DCCT) showed that the intensive glycemic control prevented diabetic complications in type 1 diabetic patients, and the HbA1c levels reduced by 1.5–2.0%. In the UKPDS study, a modest improvement in HbA1c (a difference of 0.9 %) in the intensively treated group than in the control group brought about a 25% reduction in microvascular complications and a 12% reduction in all diabetes related events. There are several methods with differing utilities and limitations existing for monitoring glycemic status in individuals. Diabetes care in India leaves much to be desired and suggested, and there is a need for efforts to increase awareness of both the patients and the doctors for better treatment and monitoring.

ECAB Diabetes and Exocrine pancreas - E-Book

Diabetes management, outcomes and prognosis are majorly affected by the lifestyle exercised by the diabetics. Diabetes has significant impact on the different facets of life. These facets tend to get overlooked in the management. The inter-relation of diabetes and marriage, sleep, travel, commute and uneven working hours seem to be trivial part of managing diabetes but are extremely important for a perfect recovery and management of the patient. Patients travelling with diabetes need to consider how to adapt their treatment programs to unfamiliar foods, irregular schedules, and varying amounts of exercise. Diabetes will be involved at every step of married life including vacations, outings, going to the movies, as well as intimate moments. Sleep and diabetes are interconnected. Sleep disorders have a slight but significant impact on diabetes management and it should be focused while attending a diabetic with sleep disorders. Shift workers make a special segment of diabetics, whose glucose monitoring and control need to be tailored in a special manner. With change in circadian rhythm and sleep pattern, diabetes management needs to be adjudged and adjusted. The main risks that arise in driving from having diabetes are hypoglycemia and the long term complications. All these aspects are being thoroughly covered in this book so as to facilitate better management of diabetes.